Tahanan Silid-balitaan – Tanggapan ng Komunikasyon Balita sa mga Stakeholder ng DHCS – Agosto 12, 2022​​ 

DHCS Stakeholder News – August 12, 2022​​ 

Minamahal naming mga Stakeholder,​​ 

Ang Department of Health Care Services (DHCS) ay nagbibigay ng update na ito ng mga makabuluhang pag-unlad patungkol sa mga programa ng DHCS.​​ 

Nangungunang Balita​​ 

Ang DHCS ay Nag-isyu ng Kahilingan sa Federal Partners para sa Monkeypox Guidance​​ 

On August 12, DHCS sent a letter to the Centers for Medicare & Medicaid Services (CMS) requesting immediate guidance for establishing a Medicare rate for the monkeypox vaccine administration.​​ 

In an effort to be responsive to our Medi-Cal beneficiaries and providers, California will submit a Disaster State Plan Amendment to seek federal approval to reimburse vaccine administration and applicable laboratory testing at 100 percent of the Medicare rate, once established. As part of this request, DHCS will seek federal approval to reimburse Federally Qualified Health Centers, and similarly situated clinics that are paid an all-inclusive rate, the vaccine administration fee for vaccine-only visits, consistent with how DHCS is reimbursing for COVID-19 vaccine-only visits. The requested federal approvals will also include reimbursement for vaccine administration performed by non-clinic providers.​​ 

Additionally, please see the Centers for Disease Control and Prevention’s Reducing Stigma in Monkeypox Communication and Community Engagement and the California Department of Public Health’s toolkit messaging for sharing broadly among your networks.​​ 

Mga Refund ng Medi-Cal Premium​​ 

Pinahintulutan ng Senate Bill 184 (Omnibus Health Bill 2022) ang DHCS na bawasan ang mga premium para sa mga programang Medi-Cal sa zero. Epektibo sa Hulyo 1, 2022, ang mga miyembrong nakatala sa mga sumusunod na programa ay hindi na kailangang magbayad ng premium bilang kinakailangan para sa pagiging karapat-dapat:​​  

  • Optional Targeted Low Income Children’s Program​​ 
  • Programa sa Pag-access ng Medi-Cal​​ 
  • Medi-Cal Access Infant Program​​ 
  • County Children’s Health Initiative Program​​ 
  • 250 Percent Working Disabled Program​​ 

DHCS released policy guidance via All County Welfare Directors Letter #22-14 and Medi-Cal Eligibility Division Information Letter #I 22-25, and is seeking federal authority to implement this policy through SPA 22-0042 and SPA 22-0034, which are pending CMS approval. Furthermore, DHCS has begun the process of issuing refunds to Medi-Cal and Children’s Health Insurance Program (CHIP) beneficiaries who overpaid their premiums as of July 1.​​ 

U.S. Surgeon General’s Comments on the Children and Youth Behavioral Health Initiative (CYBHI)​​ 

In a recent SAGE Journals article, U.S. Surgeon General Dr. Vivek H. Murthy highlighted the work that is underway through the CYBHI. The article serves as a call to action for the nation, with a stark reminder of what’s at stake in ensuring that children and youth receive the help they need when and where they need it, especially those in our most underserved communities.​​ 

The CYBHI, which includes multiple work streams that are led by five departments and offices within the California Health & Human Services Agency (CalHHS) – DHCS, Department of Health Care Access and Information, Department of Managed Health Care, California Department of Public Health, and the Office of the California Surgeon General – focuses on promoting mental, emotional, and behavioral well-being by preventing challenges and providing services, support, and routine screening for all children and youth for emerging and existing needs.​​ 

Mga Update sa Programa​​ 

Medi-Cal Outreach at Tulong sa Pagpapatala para sa mga Nakatatandang Californian​​ 

Ang DHCS ay nagbibigay ng outreach at tulong sa pagpapatala sa 28,000 matatandang may edad na potensyal na kwalipikado para sa saklaw ng kalusugan ng Medi-Cal. Nagbigay ang DHCS ng $24 milyon sa California State Association of Counties at sa California Coverage & Health Initiatives (CCHI) upang makisosyo sa mga pagsisikap sa tulong sa pagpapatala hanggang Hunyo 30, 2024. Ang mga pagsisikap ay naka-target sa:​​ 

  • Mga dalawahang kwalipikadong benepisyaryo o benepisyaryo na 65 taong gulang at mas matanda na may nakabinbing muling pagpapasiya ng pagiging karapat-dapat sa Medi-Cal.​​ 
  • Mga taong 65 taong gulang at mas matanda na nakatala na sa Medi-Cal at nangangailangan ng tulong sa pagtukoy sa pagiging karapat-dapat sa Medicare.​​  
  • Mga indibidwal na 65 taong gulang at mas matanda o may mga kapansanan na karapat-dapat para sa Medi-Cal, ngunit hindi kasalukuyang naka-enroll, kabilang ang mga karapat-dapat para sa Medicare Savings Programs.​​ 
  • Mga indibidwal na bagong karapat-dapat para sa Medi-Cal dahil sa pagpapalawak ng Medi-Cal sa mga nasa hustong gulang na 50 taong gulang at mas matanda, anuman ang katayuan sa imigrasyon.​​ 
  • Ang mga benepisyaryo ng Medi-Cal na nasa edad na 65 ay hindi pa naka-enroll sa Medicare, depende sa isang kasunduan sa isa o higit pang mga plano sa pangangalagang pinamamahalaan ng Medi-Cal (MCP) sa county na iyon.​​ 

Ang CCHI ay tutulungan ng mga organisasyong nakabatay sa komunidad na may mga taon ng karanasan sa pagsasagawa ng outreach at tulong sa pagpapatala sa mga benepisyaryo ng Medi-Cal upang matiyak na ang mga karapat-dapat para sa Medi-Cal ay nadagdagan ang access sa mga serbisyong pangkalusugan upang mapabuti ang mga resulta at mabawasan ang mga pagkakaiba sa kalusugan. Para sa higit pang impormasyon, pakibisita ang Medi-Cal Outreach and Enrollment for Older Californians webpage.​​ 

Pag-update ng Patakaran sa Pagpapatala at Muling Pagpapasiya sa CHIP​​ 

On August 3, CMS approved DHCS’ State Plan Amendment (SPA) CA-22-0035 submission, allowing DHCS to implement provisions for temporary adjustments to enrollment and redetermination policies. Effective July 1, 2022, DHCS is able to use a regulatory timeliness exception for the timely processing of CHIP applications and renewals for children in families living and/or working in state- or federally-declared disaster areas.​​ 

Sa pamamagitan ng SPA na ito, ang California ay gumagawa ng mga teknikal na pagbabago upang iayon ang mga probisyon sa pagtulong sa sakuna nito na naaprubahan sa pamamagitan ng SPA CA-17-0043 kasama ang na-update na template ng SPA sa tulong sa kalamidad na inilabas noong Marso 2022. Ang mga probisyon ng SPA na ito ay maaaring ipatupad sa mga darating na sakuna na idineklara ng estado o pederal sa pamamagitan ng pag-abiso sa CMS ng mga petsa ng bisa ng mga probisyon at mga lugar na naapektuhan ng isang kalamidad.​​ 

Mobile Crisis Services Request for Information (RFI) Inilabas​​ 

On August 8, DHCS released a RFI for the mobile crisis services benefit. The RFI invites vendors to provide DHCS with information to support training for and implementation of mobile crisis services. DHCS intends to submit a SPA to add qualifying community-based mobile crisis intervention services as a new Medi-Cal benefit, effective no sooner than January 2023. Implementing mobile crisis services is an integral part of California’s broader efforts to strengthen the continuum of community-based care for Medi-Cal beneficiaries who are experiencing a mental health or substance use disorder crisis.​​ 

Binubuo ng DHCS ang benepisyo ng mga serbisyo ng krisis sa mobile ng Medi-Cal, na magsasama ng mga materyales at gabay na nauugnay sa pagsasanay, mga pagsusuri sa kahandaan, at teknikal na tulong.​​ 

Programa sa Mga Pagbabayad sa Pagpapanatili ng Trabaho sa Ospital at Skilled Nursing Pasilidad ng COVID-19​​ 

Ang DHCS ay nagbibigay ng updated na gabay tungkol sa petsa ng record at huling petsa ng pagsusumite para sa programang ito:​​ 

  • Para sa petsa ng talaan, ang mga karapat-dapat na empleyado ay dapat na magtrabaho ng isang sakop na entity o mga sakop na serbisyo na employer sa isang kwalipikadong pasilidad bago ang Nobyembre 28, 2022, upang maging karapat-dapat para sa isang pagbabayad sa pagpapanatili.​​ 
  • Para sa huling petsa ng pagsusumite, dapat isumite ng mga sakop na entity at mga sakop na serbisyo ang mga employer ng kanilang mga aplikasyon, kabilang ang isang listahan ng mga karapat-dapat na empleyado, nang hindi lalampas sa 5 pm sa Disyembre 30, 2022.​​ 

Sa mga darating na linggo, magbibigay ang DHCS ng karagdagang gabay sa proseso ng pagsusumite at pangkalahatang mga update sa pamamagitan ng lingguhang mga anunsyo ng stakeholder at sa webpage ng Mga Pagbabayad sa Pagpapanatili ng Trabaho sa Ospital at Skilled Nursing sa COVID-19.​​ 

Update ng Hearing Aid Coverage for Children Program (HACCP).​​ 

Pinalawak ng DHCS ang mga sakop na benepisyo para sa aid code A1 upang isama ang mga bagong benepisyo ng HACCP na nauugnay sa mga bone conduction hearing device (BCHDs), na epektibo nang retroactive para sa mga petsa ng serbisyo sa o pagkatapos ng Hulyo 1, 2021.​​ 

For more information about HACCP coverage of BCHDs, please see the Medi-Cal Provider Newsflash. For information about the program more broadly, please see DHCS’ HACCP webpage, which was recently expanded to include additional resources for families and providers, including a secure chat option for communicating with the HACCP Call Center or uploading additional materials for an application that has already been submitted. Additionally, families seeking to apply for HACCP coverage may now submit their application electronically through the HACCP Online Application Portal.​​ 

Update sa Pagpapatupad ng Medi-Cal Rx​​ 

Ang DHCS at Magellan (MMA) ay nakikibahagi sa isang masinsinang proseso ng pagpaplano para sa phased reinstatement ng mga pag-edit ng claim at mga kinakailangan sa paunang awtorisasyon (PA).​​ 

  • Ang phase one, wave one, ay ipinatupad noong Hulyo 22, 2022, upang ibalik ang mga pag-edit ng claim para sa National Council for Prescription Drug Programs (NCPDP) Reject Code 88 – Drug Utilization Review (DUR) Reject Error para sa mga alerto sa DUR, tulad ng mga pakikipag-ugnayan sa droga-droga, mataas na dosis, maagang refill, atbp. Ang diskarte sa muling pagbabalik ay unti-unti at paulit-ulit, na may matinding pagtuon sa paghahanda ng stakeholder at pagsubaybay sa pagganap. Pipino ito kung kinakailangan sa paglipas ng panahon batay sa data analytics, karanasan sa pagpapatakbo, at feedback ng stakeholder.​​ 
  • Phase one, wave two, na ngayon ay may bisa, ay nakatuon sa pag-promote ng paggamit ng CoverMyMeds (CMM).​​ 
  • Phase one, wave three is slated to begin on September 16 with the reinstatement of PA requirements for 11 drug classes for new start prescriptions for beneficiaries 22 years of age and older. Stakeholders are encouraged to continue submitting comments and feedback on the reinstatement approach via Reinstatement@dhcs.ca.gov.​​  

Pag-apruba ng SPA ng Community Health Workers (CHW).​​ 

On July 26, DHCS received CMS approval for SPA 22-0001, which adds CHW as a preventive service. Developed in consultation with stakeholders, this SPA created CHW services as a Medi-Cal benefit, effective July 1, 2022, for both fee-for-service and managed care delivery systems. For more information about CHW services, including a link to the provider manual, please see the CHW webpage.​​ 

Nai-publish na Impormasyon sa COVID-19​​ 

Mga Paparating na Mga Pagpupulong ng Stakeholder at Webinar​​ 

California Advancing and Innovating Medi-Cal (CalAIM) Waiver Renewals Webinar​​ 

On August 22 at 10 a.m., DHCS will virtually host a public hearing to receive stakeholder feedback on the proposed amendments to the CalAIM Section 1115 demonstration and Section 1915(b) waiver. Please register for this webinar in advance.​​ 

DHCS launched 30-day public comment and Tribal public comment periods on August 12. DHCS is seeking the CalAIM Section 1115 and 1915(b) amendment approvals from CMS to implement county-based model changes in the Medi-Cal Managed Care (MCMC) program. Through the Section 1915(b) waiver amendment, DHCS also plans to add or update language on policies or programs in the approved CalAIM 1915(b) waiver, including to reflect the MCMC model changes in select counties and direct contracts with the Kaiser Foundation Health Plan available for enrollment of certain Medi-Cal beneficiary populations in select counties. Additional information about the CalAIM Section 1115 demonstration application and Section 1915(b) overview are available on the CalAIM 1115 Demonstration & 1915(b) Waiver webpage. The 30-day public comment and Tribal public comment periods end on September 12.​​ 

Pakikipag-usap sa mga Kliyente ng PACT ng Pamilya Tungkol sa HPV Immunization​​ 

On August 17, DHCS and the California Prevention Training Center will hold a webinar to provide information about the effectiveness and safety of the human papillomavirus (HPV) vaccine, review current Centers for Disease Control and Prevention recommendations for the use of the HPV vaccine, and provide advice on how to have effective shared decision-making conversations with clients about being immunized. Advance registration for PACT webinar is required. Effective July 1, 2022, the Family PACT program added HPV vaccination as a clinic benefit for individuals ages 19 through 45. For those unable to attend the live webinar, a transcript and recording of the webinar, along with additional resources, will be available on the Family PACT website.​​ 

Medi-Cal Dental Statewide Stakeholder Meeting​​ 

Sa Agosto 18 sa 10 am, magho-host ang DHCS ng isang virtual na Medi-Cal Dental Statewide Stakeholder meeting. Ang layunin ng pagpupulong na ito ay bigyan ang mga stakeholder ng ngipin sa buong estado ng isang forum upang magbahagi ng feedback sa programang Medi-Cal Dental, at para sa DHCS na magbahagi ng mahahalagang update at impormasyon sa mga bago at/o paparating na pagsisikap sa trabaho. Ang karagdagang impormasyon ay makukuha sa webpage ng pagpupulong ng Medi-Cal Dental Statewide Stakeholder.​​ 

DHCS CalAIM MLTSS at Duals Integration Workgroup Meeting​​ 

On August 18 at 10 a.m., DHCS will virtually host the CalAIM Managed Long-Term Services and Supports (MLTSS) and Duals Integration Workgroup meeting. Please register for the meeting, which is open to the public.​​ 

The meeting will serve as a stakeholder collaboration hub for CalAIM MLTSS and integrated care for dual eligible beneficiaries. It will also give stakeholders an opportunity to provide feedback and share information about policy, operations, and strategy for upcoming changes to Medicare and Medi-Cal. Agenda items include a summary of January 2023 enrollment changes; a presentation on the January 2023 transitions impacting dual eligible beneficiaries, including noticing, monitoring, and timelines; and an update on the Dementia Care Aware initiative.​​ 

Background materials, transcripts, and video recordings of the previous workgroup meetings, along with additional information about the workgroup, are posted on the CalAIM MLTSS and Duals Integration Workgroup webpage.​​ 

Smile, California Campaign para sa Medi-Cal Dental Services​​ 

Smile, California is hosting Facebook Live presentations for Medi-Cal members in Spanish and English. The Spanish presentation will be held on August 24 at 1 p.m.; RSVP on Facebook. The English presentation will be held on August 26 at 1 p.m.; RSVP on Facebook. A Smile, California member outreach representative will deliver the Smile, your Medi-Cal benefits include dental! presentation, and a provider relations trainer will assist with answering audience questions.​​ 

Pagsasanay sa PAVE Portal para sa mga Dental Provider​​ 

On August 24 at 11 a.m., DHCS will host a webinar introduction to PAVE for dental providers. Beginning on October 31, DHCS will implement the PAVE portal for dental providers, offering a new mode for submitting dental provider enrollment applications and required documentation to DHCS. This allows applicants to use the Medi-Cal Provider e-Form Application, as DHCS will no longer accept paper applications once PAVE is implemented. For more information about the webinar, including the registration link for the August 24 training, please view this Medi-Cal Dental Provider Bulletin. The PAVE demonstrations will be recorded and posted on the DHCS PAVE webpage.​​  

DHCS Office of Family Planning Stakeholder Meeting​​   

On August 24, DHCS will host a virtual family planning stakeholder meeting. The link to the meeting will be available on the Office of Family Planning webpage prior to the meeting.​​ 

Doula Benefit Stakeholder Meeting​​ 

On August 24, DHCS will host a virtual stakeholder workgroup meeting about adding doula services as a covered Medi-Cal benefit. The meeting is open to the public. DHCS will engage with workgroup members on policy development details that will be reflected in the Medi-Cal provider manual and other policy guidance documents. All interested stakeholders may listen to the workgroup discussion regarding stakeholder feedback and provide input via email. DHCS will also share an update on the status of formal submission of the SPA to CMS. The link for the stakeholder meeting will be available on the doula webpage prior to the meeting.​​ 

CalAIM Webinar: Enhanced Care Management (ECM) at Community Supports Member Engagement​​ 

On August 25 at 1:30 p.m., DHCS will host an all-comers webinar on CalAIM ECM and Community Supports member engagement. Topics for this session will include provider and member communications, referrals, outreach, and enrollment. This event is part of a series of technical assistance and informational sessions focused on supporting implementation of ECM and Community Supports. Throughout the series, DHCS leaders will be joined by presenters from MCPs, providers, and CBOs implementing CalAIM.​​ 

Advance registration for CalAIM webinar is required. Participants are invited to submit questions by August 22 to CalAIMECMILOS@dhcs.ca.gov. Attendees will also have the opportunity to ask questions during the webinar. An additional “Office Hours” event will be held on September 1 at 2 p.m. (see below) for attendees to ask any other questions not covered during the webinar.​​ 

CYBHI Buwanang Webinar​​ 

On August 29 at 3 p.m., DHCS will virtually host a webinar to keep stakeholders apprised of DHCS’ progress in implementing various work streams of the CYBHI. Key attendees include, but are not limited to, youth, parents, family members, behavioral health providers, Medi-Cal MCPs, county behavioral health departments, and commercial health plans, as well as education and other cross-sector partners. CYBHI Monthly Webinar advance registration is required.​​ 

Mga Oras ng Opisina ng CalAIM: Sinusuportahan ng ECM at Komunidad ang Pakikipag-ugnayan ng Miyembro​​ 

On September 1 at 2 p.m., DHCS will virtually host an “Office Hours” discussion on CalAIM ECM and Community Supports member engagement. As a follow-up to the August 25 webinar on this topic, this question and answer session will cover provider and member communications, referrals, outreach, and enrollment. This event is part of a series of “Office Hours” events focused on answering implementation questions from the field.​​ 

Advance registration is required. Participants are invited to submit questions by August 29 to CalAIMECMILOS@dhcs.ca.gov. Attendees will also have an opportunity to ask questions during the session.​​